eMedinewS
8th October 2014, Wednesday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President & Honorary Secretary General Elect IMA; Member Ethics Committee MCI; Chairman Ethical Committee DMC; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) IMSA (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMAAMS (06–07); President DMA (05–06), President IMA New Delhi Branch (94–95, 02–04)
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Dear All

The international health media is writing a lot about health crisis in Kashmir. Doctors in Kashmir want the UN to intervene before it is too late. One of our IMA members, Prashant Tanna has also being writing about the health concerns in Kashmir.

We, the office bearers of IMA want to know the truth and the ground realities.  IMA must come out with a real picture and their plan of action. Also we need to give the health minister the IMA plan and the suggestions what the government can do; Indian media has been silent so far in these issues. 

Yesterday I was informed by the HSG IMSA that IMA has so far sent 75 doctors and seen 10,000 patients in Kashmir. But that is not enough if Kashmir is moving towards an epidemic.

My view has been that if the situation mentioned in international media is correct we need to act. The government must ensure patient safety and allow no one to die.

We have seen the working of US military they work hard to save the life of even one fighting military person.

I am enclosing a net report

Dr K K Aggarwal
Sr National Vice President IMA
HSG Elect IMA

Kashmir Health Crisis

The discussion is between Dr Rita Pal and Dr KK Aggarwal of the Indian Medical Association. This is in relation to the patient safety concerns raised by local doctors in Jammu and Kashmir. This has been published in the interest of patient safety and in the public interest. The article detailing their concerns is listed below. The final outcome of the discussion was:

1. The concerns of the doctors have been forwarded to all Indian authorities.

2. Further information will be gathered in 24 hours.

3. Doctors in Kashmir will be given all the support needed.

4. Plan B if the government fails is undecided.

The Kashmir Healthcare Crisis - 'Patients Have Been Dying' Says Doctor

Posted:06/10/2014 11:07 BST;Updated:06/10/2014 11:59 BST SRINAGAR: From the troubled waters of Kashmir, Dr Rumana Makhdoomi, wrote the haunting "As Our Hospitals Drowned";and told me:-

"There is a major destruction to the main hospitals including loss of vital machines. Hospitals are in a very damp state. Dampness breeds infections. Many snakes are roaming live in the hospital".

Without international aid, the humanitarian crisis is worsening. The NY Times reported a deepening healthcare crisis with a lack of basic supplies and threats of disease epidemics. Amongst a myriad of illnesses, increasing numbers of respiratory diseases are being reported. The 70 lakh population is now left with just one hospital and Kashmir faces a healthcare crisis.

The entrenched resentment with administrative mismanagement has erupted into anger and daily protests. Bureaucratic aid blocks have made daily life impossible. While the local media frantically presented the harsh reality, India was accused of a PR stunt.

Fury has gripped the population and writs are flying citing allegations of negligence in Supreme Court hearings. The government appears to be losing its grip.

In the middle of this chaos, doctors in the front-line are bravely trying to manage the fine line between life and death without equipment or international support.

The World Health Organisation -India WHO responded but appeared unconcerned despite being shown the death rate of one hospital. Shocked by this response, the local doctors penned an evidence based rebuttal to WHO's lead, Dr Margaret Chan. The letter outlined the serious obstacles faced by the medical teams there.

"Government of India inputs, are factually incorrect, and a complete misrepresentation of the dire situation on ground," they wrote while detailing the serious threats posed to patient safety.

WHO India stands accused of misleading the public in this letter here.

The WHO said "All medical supplies that have been requested by the state government have been provided". The doctors disagreed with this assessment and wrote:
 "This contention is refuted by the fact that local voluntary groups such as Athrout, Help Poor Voluntary Trust and others have been requested by government hospitals to arrange medicines as the government is unwilling to assist. Further, disturbing reports suggest that medicine that was provided by the army to SMHS recently was in fact expired. Confirmed reports suggest that as far as medical supplies are concerned, the hospitals are purely managing on voluntary contributions and supplies. These supplies are also in danger of being restricted by the government." They finally wrote:- In reality, despite a passage of one month since the floods hit Srinagar city, neither Government of India, nor Government of Jammu and Kashmir, have made any efforts to rebuild the healthcare system."

Kashmir Voluntary Doctors Organisation's Dr O. Akhtar who initially tweeted his utter shock at WHO India's assessment said: "The other day, a patient who had suffered an electrocution came to SMHS hospital. According to my colleagues there, they could not manage her there, and ended up referring her to SKIMS. She lost her life on the way. I think people in the administration don't understand that a tertiary care hospital, to function as a tertiary care hospital, needs to have an oxygen supply, proper diagnostic facilities, a reliable power back up, a semblance of intensive care". His blistering critique of WHO India response read "Firstly, the maternity hospital is NOT functioning and is unlikely to be functional for at least ten days from now. Secondly, no mention of the fact that the pediatric hospital is down. SKIMS single ward neonatal unit is simply not equipped to handle the rush. And patients have been dying."

In the meantime, a fuming press release from Doctors Association Kashmir announced a Public Interest Litigation. They wrote: "DAK will file a Public Interest Litigation (PIL) seeking a probe into hospital deaths during floods. There was no alert to hospitals and the stranded patients were not rescued timely with the result 13 precious lives were lost in SMHS and scores of infants died in GB Pant and LD hospitals. We are moving to court to fix responsibility of deaths and punish people involved in criminal negligence."

With time racing forward to a severe winter of discontent, the doctors of Kashmir have requested international assistance from the World Health Organisation and the United Nations. They state that their own administration is in “deep slumber, shying away from their responsibility as if they have nothing to do with the difficulties of people". It is clear that patient safety is in jeopardy in Kashmir and this is an emergency call for assistance before it’s too late.

News Around The Globe

  • The rates of endovascular coiling for unruptured aneurysms among Medicare beneficiaries ranged from a low of 35.0% in Modesto, Calif., to a high of 98.6% in Tacoma, Wash, Kimon Bekelis, MD, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H.,and colleagues found. For ruptured aneurysms, similar variation in the rate of coiling was seen– ranging from 36.3% in Atlanta to 98.8% in Fort Lauderdale, Fla., according to the Dartmouth Atlas of Health Care report.
  • A novel, comprehensive lifestyle intervention has shown promise in reversing memory loss related to Alzheimer's disease (AD), preliminary research suggests. Through this lifestyle intervention, "it appears we can correct this network imbalance by tweaking it at multiple sites,” said Dr Bredesen in the journal Aging.
  • Medicare in US is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released Wednesday show. Last year, nearly 18 percent of Medicare patients who had been hospitalized were readmitted within a month. Roughly 2 million patients return a year, costing Medicare $26 billion. Officials estimate $17 billion of that comes from potentially avoidable readmissions. High readmission rate can be indicator of poor quality care.
  • Long–acting insulin analogs provide better glycemic control than intermediate–acting insulin and are less likely to cause either weight gain or severe hypoglycemia in patients with type 1 diabetes, suggests a new network meta-analysis published online October 1 in the BMJ.
  • A new study published in the journal Dermatology and Therapy suggests that a compound derived from red grapes and found in red wine–resveratrol – may be an effective treatment for acne, particularly when combined with an already existing medication for the disorder.

Dr KK Spiritual Blog

It’s safe to watch lunar eclipse

It’s safe to watch total lunar eclipse. Unlike solar eclipse watching total lunar eclipse does not damage the eyes. It’s safe for pregnancy as per alllopathy but Ayurveda restricts it to be watched by pregnant ladies.
On lunar eclipse day there is “full moon” present in an atmosphere of “new moon”. The full moon effect on the environment also reflects on the mood and mind of a person. The high tides in the ocean reflect in the mind as mood disturbance. These mood changes may occur in every full moon and that is the reason why in India mythology it is advised to control the mind by observing fast either on ekadashi (3 days before full moon) or on the day of full moon.

The ‘sutak’ (nine hours period before the lunar eclipse starts) is also observed in Indian mythology as a period of physical and mental fast so as to avoid the effect of eclipse on the mind. During this period one is required not to eat cereals, if possible nothing by mouth and do pranayama and meditation.

Ten percent of the society at any given time is affected with anxiety or depression. The full moon as per Ayurveda is said to effect and exacerbate symptoms of anxiety or depression. The fluctuations in the mind can also be associated with fluctuations in upper systolic blood pressure.

In an Institute of Psychiatry & Human Behavior, Goa study a significant trend was observed for greater numbers of patients withnon-affective psychoses on full moon days and on days of visible lunar eclipse, but no pattern was observed for mania or depression. -Indian J Psychiatry. 1999 Jan; 41(1):60-5.

If one believes in Indian mythology then one should observe the rituals as the fear of harmful effects of the mind for example in a pregnant lady can harm the fetus based on a common Vedic saying and principle “ you are what you think”

Facts and Myths

  1. Watching lunar eclipse does not damage the eyes. On the other hand watching directly at the sun without appropriate protection, during a solar eclipse, can cause severe temporary retinal injuries.
  2. There is no mention about harmful effects of eclipse on pregnancy in Allopathy literature.
  3. In Mexico and in many parts of India there is a ‘belief’ that pregnant woman are in danger of having a baby with a harelip during a solar eclipse. No such belief is for lunar eclipse.
  4. Ayurveda mentions indirectly it under “air space vikrity” (disorders) and writes that the effect of these disorders on pregnancy can lead to blind child or a child with low body energy. It also says that the child may be born with dog and elephant characteristics. It does not mention the word “eclipse” anywhere.
  5. As both Ayurveda and Dharma Shastra directs pregnant ladies to take precautions one should take them as otherwise the fear of giving birth to an abnormal child can cause abnormalities in the child. Those who have faith or fear that eclipse can harm pregnant ladies should take precautions.
  6. Lunar eclipse may be associated with exacerbation of mental illnesses. In an Institute of Psychiatry & Human Behavior, Goa study a significant trend was observed for greater numbers of patients with non-affective psychoses on full moon days and on days of visible lunar eclipse, but no pattern was observed for mania or depression. (Indian J Psychiatry. 1999 Jan; 41(1):60-5.
  7. There are some studies which talk about effects of full moon on rise in blood pressure, pulse and abnormal mental behavior and have linked them to high tides in the ocean.
  8. Traditional Ekadashi vrata (fast) 3 days before and fast on the day of full moon are advocated in Indian mythology to tame or control the mind which is likely to get disturbed during full moon and lunar eclipse time.
  9. The ritual of observing Nirjala ekadashi 3 days before the current lunar eclipse on full moon day with vrata is also done with the belief that it prevents mental disturbances during full moon and during lunar eclipse by producing some dehydration in the body and the brain.
  10. More mosquitoes may grow during lunar eclipse. In a study of mosquitoes in coastal marshland site in Chambers County, TX done in 1989 it was shown that the density of certain species of the mosquitoes Aedes, Anopheles, Culex, and Psorophora increased during the lunar eclipse and decreased when the full moon was exposed. -J Am Mosq Control Assoc. 1994 Jun; 10 (2 Pt 1):222-4.
  11. In another study Dr. Thornton has shown that dogs reject food while an eclipse was in progress.
  12. There are also some Vedic beliefs on this subject: There is mention of eclipse in Shikshapatri where Bhagwan Swaminarayan says that at the time of a solar or lunar eclipse in areas where it is seen one should stop all activities, meditate or chant the name of God in a purified state and after the eclipse one should take cold bath with the clothes they are wearing and then make donations (especially cereals) according to their means. (Shik 86/87). One should also not eat 12 hours before the solar and 9 hours before the lunar eclipse begins. One can drink water. One should not offer meals to God during this pre-eclipse period but can perform arti and pray. One should get rid of extra cooked food after the solar or lunar eclipse. One should not touch anything such as clothes, food, personal items, etc. during the eclipse.
  13. The only scientific explanation for the above is in lunar eclipse the atmosphere behaves like amavasya (new moon) on purnima (full moon) day. Therefore one needs to take precautions of both purnima (observe fast to prevent mental disturbances) and of new moon or amavasya (to prevent causalities occurring due to darkness in the outside atmosphere). Also on the full moon day one can have windy and dusty air in the atmosphere. With a possible dark, windy and dusty atmosphere on lunar eclipse full moon day one may end with dust settling on the laid food or cloths and hence may be the reason of the ritual of not eating food laid over 9 hours before the eclipse and till the eclipse is over. Same is true for the dirt filled cloths which one is suppose to wash it after the eclipse is over.
Inspirational Story

The King's Teeth

Once there was a king who dreamt that he lost all his teeth. The king then summoned two dream interpreters to decipher to him the meaning of his dream. The first man told the king that the dream means that all the royal family would die. Hearing this, the king had the guards beat and punish him.

On the other hand, the second man told the king that the dream means that the king would live longer than the royal family, which actually means that the royal family would perish first. Because of his wise words, the king granted him a treasure gift.

People can escape perils in life by acting rightly, saying rightly and doing things at the right time. The same meaning delivered in different way may produce differing effect.

Rabies News (Dr A K Gupta)

Why do some people fear the vaccine?

In the past, rabies vaccine was a sheep brain derived Nerve Tissue Vaccine (NTV) and was associated with considerable side effects. Large volumes and a number of injections were required. So, rabies vaccine acquired the dubious reputation of a dangerous vaccination. However, these fears are no longer justified with modern rabies vaccines that are very safe.

Cardiology eMedinewS

  • A new study published in the Journal of the American Heart Association reports that there may be a significant association between living near a major roadway and the risk of high blood pressure. Study authors noted that women who lived within 100 meters of a highway or major arterial road had a 22% greater risk of hypertension than women who lived at least 1,000 meters away.
  • According to new research published in the Journal of the American Heart Association, having few friends, family and lower social support appear to be associated with poorer health and quality of life and more depressive symptoms in young men and women a year after having a heart attack.

Pediatrics eMedinewS

  • Scientists have discovered a mechanism that promotes the progression of medulloblastoma, the most common brain tumor found in children. It has been noted that a protein known as Sonic Hedgehog induces DNA damage, which causes the cancer to develop. The research will be published in the October 13 issue of the journal Developmental Cell.
  • Adolescents with strong working memory are better equipped to escape early drug experimentation without progressing into substance abuse issues, suggests a study published online in the journal Development and Psychopathology.

Quote of the Day

It is good to have an end to journey toward; but it is the journey that matters, in the end. Ursula K. LeGuin

IMA NEWS

  • Parents being open and communicative about sexuality with children has always been encouraged by psychiatrists. Dr T Sathyanarayan Rao, the recently appointed secretary of the Human Sexuality section of the World Psychiatry Association, believes that proper sex education would go a long way in solving several social problems of the country. Mysore-based Dr Rao, a world-renowned psychiatrist and sexologist, was in the city during the World Mental Health Week. The local chapters of Indian Psychiatric Society and Indian Medical Association had decided to focus on adolescent mental health issues.
  • People in the disaster affected areas of Jammu and Kashmir are reeling under severe health problems and economic difficulties. They require long-term planning for a comprehensive health care, economic uplift through massive aid by the central government. This was the impression gathered by the medical relief team which left Ludhiana on September 27 and returned on October 3. The mission was a joint effort by Indian doctors for peace and development, Indian Medical Association, Ludhiana, Rotary club Ludhiana Greater, Wholesale Chemists Association, Ludhiana District Chemist Association, All India Bank Officers Association and All India Youth Federation.

Wellness Blog

Crowd management

Dr K K Aggarwal

  • Use barriers. However barriers in some cases may funnel the crowd towards an already–packed area, such as in the Hillsborough disaster that occurred at the Hillsborough Stadium in Sheffield, England.
  • Use loudspeakers to communicate and direct a crowd.
  • Warning signs of a crowd crush include density of more than four people per square meter, at which each person is being touched on four sides. It's a disaster if there are more than 10 people per square meter
  • To avoid or escape from a crowd crush, one is advised to move sideways, particularly between swells.
  • After the stampede in the Victoria Hall disaster in 1883, a law was passed in England, which required all public entertainment venues to be equipped with doors that open outwards.
  • Most deaths are due to asphyxia, something what happens in SVC obstruction.
  • National Disaster Management Agency (NDMA) has released a set of guidelines for crowd control at places of mass gatherings, suggesting deployment of snake line approach, constant monitoring of crowds for developing hazard points, alternative routes to release crowd pressure and accessibility of emergency exits at all times. 
  • There should be a 3-4 meter gap in between a row of 5-6 shops, though which pilgrims can escape during an unexpected rush.

NDMA guidelines:

http://www.ndma.gov.in/images/pdf/managingcrowdsguide.pdf

ePress Release

Depression, severe mental illness and loneliness not heart friendly

Depression, severe mental illness and loneliness are linked to heart disease and dementia, said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India.

Quoting Dr. Jesse Stewart, formerly of the University of Pittsburgh School Of Medicine, Dr Aggarwal said that there is correlation between depression and hardening of the arteries.

The arteries of those who are most depressed were narrowed twice as much as those who were least depressed, in the study. Hardening of the arteries is a precursor to a heart attack or stroke.

Depression may also upset the body’s regulation of glands that release chemicals governing energy level and growth, and alter the functioning of cells responsible for blood clotting.

Hardening of the arteries leads to an overreaction of the immune system and the resulting inflammation is known to release chemicals that can cause the disease.

Quoting a British study, Dr Aggarwal said that severely mentally ill people are more than three times as likely to die from coronary heart disease and stroke as those not suffering from mental illness.

Mental illness more than doubled the risk of dying from heart disease for people up to the age 75. The risk of dying from heart disease was even higher among those taking antipsychotic medications.

A persistent feeling of loneliness among the elderly doubles the risk of developing Alzheimer's-like symptoms compared to those who felt connected to others.

eMedi Quiz

All of the following are TRUE regarding HIV infection in children except:

a. Most of the children present with clinical symptoms during the neonatal period.
b. They usually present with non specific symptoms of immunodeficiency
c. Skin is one of the most commonly involved organs with HIV infections
d. Children may remain asymptomatic up to the age of 8-10 years

Yesterday’s Mind Teaser:Granulocytopenia, gingival hyperplasia and facial hirsutism are all possible side-effects of one of the following anticonvulsant drugs.

1. Phenytoin.
2. Valproate.
3. Carbamazepine.
4. Phenobarbitone.

Answer for yesterday’s Mind Teaser:1. Phenytoin.

Correct answers received from: Dr.K.V.Sarma, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Avtar Krishan, Najib Khatee

Answer for 6th Oct Mind Teaser:2. Griseofulvin.

Correct answers received from:: Dr. P. C. Das

Send your answer to email

 

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at SGSS Vidyalaya, Chirag Dehli on 22nd September 2014

mela_brochure
Self-Assessment-Quiz

 

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Zee News – Health Wealth Shows

Alcohol

press release

Uric acid and endothelial dysfunction

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Video Library

MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 96458 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and Dr Bad

Situation: A patient diagnosed with falciparum malaria came for prescription.
Dr Bad: Take quinine plus tetracycline.
Dr Good: Take artesunate.
Lesson: Artesunate (to be given in combination) is preferred over quinine in combination with tetracycline in patients with uncomplicated falciparum malaria as it is more effective, better–tolerated and more cost effective.

 

Make Sure

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria.
Reaction: Oh my God! Why did you not advise a macrolide?
Lesson: Make sure to remember that macrolide are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

eMedinewS Humor

Trouble on the Roof

Mike and Rob were laying tile on a roof when a sudden gust of wind came and knocked down their ladder.

"I have an idea," said Mike. "We'll throw you down, and then you can pick up the ladder."

"What, do you think I'm stupid?" Rob replied." I have an idea. I'll shine my flashlight, and you can climb down on the beam of light."

"What, do you think I'm stupid?" Mike answers. "You'll just turn off the flashlight when I'm halfway there."

Twitter of the Day

Dr KK Aggarwal: Poor hygiene habits may lead to Typhoid fever

Dr Deepak Chopra: Awareness is a field in which minds, bodies & universes arise & subside like waves on an ocean

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Can the court give compensation more than the amount asked?

A: Raj Rani & Ors. vs. Oriental Insurance Company Ltd. & Ors.  (2009 SCC 13, 654) in which the Apex Court has observed: “…..there is no restriction that compensation could be awarded only up to the amount claimed by the claimant.  In an appropriate case, where from the evidence brought on record if the Tribunal/court considers that the claimant is entitled to get more compensation than claimed, the Tribunal may pass such award (para 14).”

medicolegal update
  1. Dr. KK Aggarwal, My Hearty Congratulations on being elected as National IMA Secretary General Elect. With Regards: Dr. Ajay Govardhan, President IMA, Durg, Chhattisgarh, President-Elect IMA Chhattisgarh state.

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